Nicolai Leontievich Volodos (Nikolay, Nikolai, Nicholas), (, ; 15 May 1934 – 3 April 2016) was a Soviet/Ukrainian cardiovascular surgeon and scientist. An innovator, Volodos developed and introduced into clinical practice the world's first endovascular stent graft for the treatment of stenotic and aneurysmal diseases of arterial system.Ivancev K, Vogelzang R. ESVS 2019 Volodos Honorary Lecture: A 35 Year History of Stent Grafting, and How EVAR Conquered the World. Eur J Vasc Endovasc Surg 2020; 59:685-694. Volodos was described by his colleagues as "a pioneer innovator and a giant in vascular and endovascular surgery"Peter Gloviczki. ESVS Volodos Lecture: Innovations and the Hippocratic Oath. Eur J Vasc Endovasc Surg. 2018 May;55(5):605-613. and "a giant of historic proportions in the vascular and endovascular specialties, and the father of endovascular grafting".Frank J Criado. Nicholay Volodos and the Origins of Endovascular Graft. Vascular Disease Management. Volume 9 - Issue 7 - July 2012.
Early life Volodos was born in a small village Kokoshchitsi, near Slonim, Nowogródek Voivodeship (1919–1939), Poland. He was the second of three brothers.
Years of activity
1952–1958 – Medical student at Odesa Medical Institute (currently Odesa National Medical University ), Odesa, Ukraine;
1958–1962 – General surgeon in Hirske, Luhansk Region, Ukraine, then Head of the Department of General Surgery at the Karbonit local hospital in Zolote, Luhansk Region, Ukraine;
1962–1965 – Postgraduate student at the Department of Thoracic Surgery and Anesthesiology, Ukrainian Institute of Postgraduate Medical Education, Kharkiv, Ukraine;
1964–1965 – Head of Ukraine's first Vascular Surgery Department, Kharkiv City Hospital No. 2;
1965–1972 – Head of the Department of Vascular Surgery, Ukrainian Institute for Hemotransfusion and Emergency Surgery (later, the Kharkiv Scientific and Research Institute for General and Emergency Surgery), Kharkiv, Ukraine;
1970 – Assistant at the Department of Thoracoabdominal Surgery, Ukrainian Institute of Postgraduate Medical Education, Kharkiv, Ukraine;
1971 – Ph.D. in medical sciences;
1972–2001 –Head of reorganized Department of Vascular Surgery at the Kharkiv Scientific and Research Institute for General and Emergency Surgery, Kharkiv, Ukraine;
1987 – Doctoral degree in medical sciences;
1992 – Professor at the Department of Cardiology and Functional Diagnostics, Ukrainian Institute for Postgraduate Medical Education, Kharkiv, Ukraine;
1992–2013 – Head of the Kharkiv Center for Cardiovascular Surgery, which Volodos founded in Kharkiv, Ukraine.
Professional achievements
Volodos started his surgical career after graduating in 1958 from the Odesa Medical Institute in Odesa, Ukraine. During 1958–1962, he first worked as a general surgeon in Hirske, Luhansk Region, then as head of the Department of General Surgery at the Karbonit local hospital in Zolote, Luhansk Region. In 1962, Volodos become a postgraduate student at the Department of Thoracic Surgery and Anesthesiology of the Ukrainian Institute of Postgraduate Medical Education in Kharkiv, under the direction of legendary Soviet and Ukrainian surgeon Professor Alexander Shalimov. Under the supervision of Professor Shalimov and following his recommendations, Volodos performed experimental research on roentgenologic contrast examination and surgical treatment of coronary artery disease in dogs.Volodos NL, Shalimov AA. [Some issues of coronary insufficiency]. Grudnaya Khirurgiya. 1968;(3):91-5. RussianVolodos NL. [Selective coronarography]. Grudnaya Khirurgiya. 1968;(3):146-50. Russian. That work was the subject of Volodos' Ph.D. thesis.
Shalimov performed many different types of surgery, including general, oncological, vascular, and cardiovascular operations. In 1963, Professor Shalimov established Ukraine's first vascular surgery department at Kharkiv City Hospital No. 2 (renamed after Alexander Shalimov in 2016). And, in 1964, Shalimov appointed Volodos head of the department. In 1965, Shalimov was appointed head of the Ukrainian Institute for Blood Transfusion and Emergency Surgery (later reorganized into the Kharkiv Scientific and Research Institute for General and Emergency Surgery). Volodos followed his mentor and became its head of Vascular Surgery department. In 1972, Shalimov left Kharkiv and moved to Kyiv to establish his new Institute for Surgery and Transplantation (now the Shalimov National Institute for Surgery and Transplantation), and Volodos assumed the role of senior vascular surgeon for the Kharkiv region, as well as Poltava, Sumy and Belgorod. In 1972, Volodos became the first surgeon in the Kharkiv region to perform selective coronary angiography and ventriculography in patients with ischaemic coronary artery disease. Then, in 1974, he was the first to perform an aortocoronary bypass procedure in Kharkiv.
Having been trained by Professor Shalimov, Volodos based his approach to clinical practice on Shalimov's two principles:
Everything a doctor does should be centered on the needs of the patient.
If you do not know of a treatment that will help your patient, invent one.
In January 1977, Volodos became the first surgeon in the Soviet Union to perform replantation of the arm after its traumatic transhumeral amputation. The case was described in the central press and became the catalyst for the beginning of microsurgery as a surgical specialty in Soviet medicine. Soon after that, new specialised microsurgical centers were founded in different regions of the Soviet Union.
In that same year, Volodos also performed Ukraine's first successful surgical repair of traumatic rupture of thoracic aorta.Volodos NL, Goloborodko NK, Mikhailenko VV. [Surgical treatment of traumatic rupture of the thoracic aorta]. Grudnaia khirurgiia. 1981;(6):76-8. Russian. PMID 7333515. Soon after that, Volodos initiated several projects to improve the clinical examination and treatment of patients with diseases of the aorta and its branches. This included making advances in minimally invasive surgery for the treatment of aortic aneurysms. Volodos and associates developed the world's first stent graft, which was successfully used by him in clinic.Volodos NL, Shekhanin VE, Udovenko VF, Karpovich IP, Troian VI. [Radial zigzag spring, self-fixing synthetic prosthesis for remote endoprosthetics of blood vessels]. Kharkiv: FTINT; 1987. 35 p. (Preprint; 1987). Russian. That project resulted in the creation of the Z-stent (a self-expanding stent graft), and multiple delivery systems, which made new typed of endovascular procedures possible. Volodos developed the principle of building an endovascular stent graft as combination of a stent as its attachment mechanism and a vascular graft. Valves for transcatheter aortic valve implantation (TAVI); biliary, tracheal, and rectal stent grafts (currently called covered stents); and endovascular stents for peripheral arteries are all built on the same principle.
Volodos promoted the concept that vascular and endovascular surgery should be developed as an independent specialty in its own right. He founded the Kharkiv Center for Cardiovascular Surgery (KhCCVS) in 1992, which then evolved into an independent organization with its own clinical and scientific divisions. He remained head of the KhCCVS until his retirement in 2013.
Before joining any Western professional societies, Volodos was a member of the Association of Cardiovascular Surgeons of Ukraine and the Russian Society of Angiologists and Vascular Surgeons.
Stent graft project
Volodos and members of his team primrily published in Russian and Ukrainian.VI Troian, AV Chinilin, VA Prasol. [History of activity and role of Professor N. L. Volodos in the development of national and world’s cardiovascular surgery. To the 85th anniversary of his birth.]. Medichna gazeta "Zdorovja Ukraini". Veresen 2019. Russian. .
Volodos and associates officially started their project in the early 1980s, after developing the Z-stent, an attachment mechanism for the stent graft in the form of a "radial zigzag-shaped cylindrical spring". Volodos named the new combination of the fixing element and synthetic vascular graft an "endoprosthesis", and he called the clinical practice of implanting these devices "remote endoprosthetics". The self-expanding endoprosthesis was patented by Volodos and associates in 1984 (USSR patent of 22 May 1984).
In December 1983, animal studies of the new devices in dogs and testing of the first delivery systems on human cadavers began. Before that, the original Z-stents were produced and tested on specially developed equipment. The first stents were made of medical stainless steel, in diameters of 0.6 and 0.7 mm. Before the stent was used as a part of stent graft, its properties were designed theoretically and calculated mathematically, particularly the radial force required for the safe fixation of the stent graft in human aorta under different conditions of pulsatile flow.
Volodos performed the first human implantation of the fabric-covered Z-stent on May 5, 1985, to treat iliac artery stenosis, in combination with elective femorotibial bypass grafting, in a patient with multilevel atherosclerotic lesions of lower-limb arteries, with good clinical results.Volodos NL, Shekhanin VE, Karpovich IP, Troian VI, Goncharova LS. [Remote endoprosthetics of the aorta and iliac arteries]. In: [Topical issues in organization of prevention and surgical treatment of the main vessels diseases. Abstracts of the All-Union Conference]; 1985 Mar 20-22; Moscow. Part 2. Moscow; 1985. p. 163. Russian.Volodos NL, Shekhanin VE, Karpovich IP, Troian VI. [Remote endoprosthetics of the aorta and iliac arteries with a self-fixing synthetic prosthesis]. In: [Topical issues of surgery. Abstracts of the 5th Scientific Conference of Surgeons of the Latvian, Lithuanian and Estonian SSR]; 1985 Dec 5-6; Tallinn. Tallinn; 1985. p. 217-8. Russian.Volodos NL, Shekhanin VE, Karpovich IP, Troian VI, Gurev IuA. [A self- fixing synthetic blood vessel endoprosthesis]. Vestnik khirurgii imeni I. I. Grekova. 1986 Nov;137(11):123-5. Russian. PMID 3824776. PMID 3824776. During 1985 and 1986, Volodos performed 3 similar procedures with good results.
In 1986, Volodos started using bifurcated stent grafts for intraoperative grafting of the abdominal aorta. This shortened the time for which the vessel had to be clamped.
Volodos performed the first aortic stent graft implantation on March 24, 1987, to treat a post-traumatic thoracic aortic aneurysm.Volodos NL, Karpovich IP, Shekhanin VE, Troian VI, Iakovenko LF, Keremet LS, et al. [A case of distant transfemoral endoprosthesis of the thoracic artery using a self-fixing synthetic prosthesis in traumatic aneurysm]. Grudnaia khirurgiia. 1988 Nov-Dec;(6):84-6. Russian. PMID 3220297. Over a follow-up period of 18 years, the patient had no complications. The patient died in 2005 because of pathology not related to the stent graft implantation.Volodos NL. The origin of TEVAR. In: Chiesa R, editor. History of Aortic Surgery in the World. Turin: Edizioni Minerva Medica; 2015. p. 2-10.Volodos NL. The 30th Anniversary of the First Clinical Application of Endovascular Stent-grafting. Eur J Vasc Endovasc Surg. 2015 May;49(5):495- 7. doi: 10.1016/j.ejvs.2015.02.012.